Name of the Procedure:

Thyroidectomy (Commonly called Thyroid Surgery)

• Substernal Thyroid; Cervical Approach

Summary

A thyroidectomy is a surgical procedure to remove all or part of the thyroid gland. When performed via the cervical approach, the surgery is conducted through an incision in the neck to address the substernal (below the sternum) extension of the thyroid gland.

Purpose

The primary purpose of a thyroidectomy is to treat conditions involving the thyroid gland, such as:

• Thyroid cancer
• Large goiters causing compression symptoms
• Hyperthyroidism or Graves' disease unresponsive to other treatments

The goal is to remove the problematic thyroid tissue to alleviate symptoms, prevent complications, and, in cases of cancer, eliminate malignant cells.

Indications

Patients may be recommended a thyroidectomy if they experience:

• Persistent hoarseness, difficulty swallowing, or breathing due to a large goiter
• Suspicious thyroid nodules indicative of cancer
• Overactive thyroid (hyperthyroidism) not manageable with medication or radioactive iodine
• Cosmetic concerns due to large thyroid nodules or goiters

Preparation

• Patients may be advised to fast for 6-8 hours before surgery.
• Certain medications, such as blood thinners, may need to be paused.
• Pre-operative blood tests and imaging studies like ultrasound or CT scans may be performed.
• A thorough medical evaluation, including history and physical examination.

Procedure Description

1. The patient will be placed under general anesthesia to ensure they are unconscious and pain-free.
2. A small incision is made in the lower central part of the neck.
3. The surgical team carefully dissects down to the thyroid gland, preserving important structures like the parathyroid glands and the recurrent laryngeal nerve.
4. The surgeon removes the thyroid tissue, addressing any substernal extension through the cervical approach.
5. The incision is then closed with sutures or surgical glue, and a small dressing is applied.

Duration

The procedure typically takes between 2 to 4 hours.

Setting

Thyroidectomy is performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon (typically an otolaryngologist or general surgeon specializing in endocrine surgery)
• Anesthesiologist
• Surgical Nurses
• Scrub Technicians

Risks and Complications

• Common Risks: Bleeding, infection, scarring, and soreness.
• Rare Risks: Damage to the parathyroid glands resulting in hypocalcemia, injury to the recurrent laryngeal nerve causing vocal cord paralysis, complications related to anesthesia, and need for additional surgeries.

Benefits

• Relief from symptoms such as difficulty swallowing or breathing.
• Removal of cancerous tissue to prevent spread.
• Improved quality of life with resolution of hyperthyroidism symptoms.
• The full benefit can be realized within weeks to a few months post-surgery.

Recovery

• Hospital stay for 1-2 days post-surgery.
• Pain is managed with medications; discomfort usually diminishes within a week.
• Restricted activities for the first few weeks, avoiding heavy lifting and strenuous exercises.
• Follow-up appointments to monitor healing and thyroid hormone levels, which may require lifelong supplementation.

Alternatives

• Medication: Antithyroid drugs for hyperthyroidism, but may not be effective in all cases.
• Radioactive Iodine Therapy: Used primarily for hyperthyroidism and certain cancers; not suitable for large goiters or compressive symptoms.
• Observation: Regular monitoring for small, asymptomatic nodules.

Each alternative has its pros and cons regarding effectiveness, side effects, and patient suitability.

Patient Experience

• During the procedure: The patient is under general anesthesia and will not feel anything.
• After the procedure: Expect some neck pain and discomfort, managed with pain relievers. Swelling and slight bruising at the incision site are common. Regular follow-up visits will ensure proper healing and hormone level balance.

Pain management and comfort measures at home include taking prescribed medications, using ice packs to reduce swelling, and resting as needed.